Individual provider Active NPI

Marlee R Pratt, FNP

  • Family Nurse Practitioner
  • Portage, IN
National Provider Identifier
1225461585
Registry record updated Jan 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
71004615A Issued in IN
Practice address
3190 Lancer St
Portage, IN 46368-4488
Phone
(219) 764-3600
NPI assigned
Aug 9, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 71004615A IN Primary
Registered Nurse 163W00000X 28164906A IN

Addresses

Primary practice location

3190 Lancer St
Portage, IN 46368-4488

Mailing address

3190 Lancer St
Portage, IN 46368-4488
Phone (219) 764-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131204001059 IN Practitioner - Nurse Practitioner 7517193170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Dermatology Institute, LLCGroup PAC ID 7911043054, 51 clinicians

Practice addresses (Care Compare)

3190 Lancer St
Portage, IN 46368-4488
Phone (219) 764-3600

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
71004615AINMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Dermatology Institute, LLC CurrentSince Jan 1, 2022 Accepting new patients
Northern Indiana Dermatology and Skin Surgery Center PastSince Jan 1, 2022 Accepting new patients
Decatur Memorial Hospital Past Accepting new patients

Locations

2622 Momentum Pl
Chicago, IL 60689

11061 Broadway
#B
Crown Point, IN 46307
Phone (219) 232-9209

1225 E Coolspring Ave
Michigan City, IN 46360
Phone (219) 873-2919

9601 Calumet Ave
Ste E
Munster, IN 46321
Phone (219) 491-3376

3190 Lancer St
Portage, IN 46368
Phone (219) 764-3600

3190 Lancer St
Ste 101
Portage, IN 46368

Interoperability endpoints

  • Direct secure messaging: mprattt@illinois.emadirect.md

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1225461585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3190 LANCER ST",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684488",
            "telephone_number": "219-764-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3190 LANCER ST",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463684488",
            "telephone_number": "219-764-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATT",
        "first_name": "MARLEE",
        "middle_name": "R",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-09",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71004615A",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IN",
            "license": "28164906A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, IN

Sources for this page

Verify at the official NPI Registry.